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Trials designed to inform clinical practice in the real world are referred to as pragmatic trials. They are usually characterized by a focus on the practical aspects of the research design, like the recruitment process and consent, adherence, and the use of routinely available equipment.

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Another example of a pragmatic trial is the Home Blood Pressure Management (HBPM) study, which utilized various investigators and participants from different geographic areas. This type of heterogeneity which is essential for a pragmatic trial to be reliable and lessen the chance of bias is also essential. A high degree of heterogeneity, however could cause issues with the design of the trial.

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The aim of pragmatic trials is to simulate real-life situations and achieve maximum credibility externally. They are usually ordered by policymakers and practitioners in order to guide their decisions. They can be used to determine the causal relationship between an intervention with its outcomes. However, they should not be used as a substitute for explanation studies.

The pragmatism idea is controversial, and there are doubts about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 made the distinction between explanation studies, which confirm the physiological hypothesis or clinical hypothesis, and pragmatic trials, that inform the practice and policy decision-making. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool attempted to define the traits of a pragmatic research study that includes recruitment, design, delivery of the intervention, and follow-up.

The number of pragmatic trials is increasing. A recent Medline search using the terms pragmatic and naturalistic, restricted to randomized controlled trials (RCTs) produced 34 articles, which are shown in red in Figure 2. This suggests that the health sciences community has become more aware of the importance of pragmatic thinking. It is important to keep in mind that the majority were conducted in primary care settings.